Claim total
$174.81
base $93.39 · payer covered $124.81
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2020-12-05
- Stop
- 2020-12-05
The parties
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-a711-7fdd79b62c73